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Siddiqui HP, Sennimalai K, Kaur A, Selvaraj M, Monga N, Mohaideen K. Does the adjunctive use of autologous platelet concentrate during secondary alveolar bone grafting reduce the risk of wound dehiscence? A systematic review and meta-analysis. J Craniomaxillofac Surg 2024; 52:895-905. [PMID: 38729847 DOI: 10.1016/j.jcms.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/10/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024] Open
Abstract
Wound dehiscence is a common complication after secondary alveolar bone grafting (SABG), leading to unfavourable surgical outcomes. Studies have shown that autologous platelet concentrates (APC) may enhance wound healing and improve outcomes. Therefore, this review aimed to evaluate in patients with alveolar clefts, whether using APC and iliac crest bone graft can mitigate the likelihood of wound dehiscence formation compared with those who underwent iliac bone grafting only following SABG. A comprehensive literature search was conducted using various electronic databases, including PubMed, Embase, Scopus, Web of Science, EBSCOhost, Ovid MEDLINE, LILACS, Cochrane Library, and grey literature, to include studies until July 31, 2023, without any restriction to language and time of publication. Only randomized (RCT) and controlled (CCT) clinical trials were included. Two independent reviewers screened the studies based on the predefined criteria, after which a qualitative and quantitative analysis was conducted. The search yielded 821 studies, of which seven were deemed eligible for systematic review. The risk of bias assessment done using "The Cochrane collaboration tool for risk of bias assessment" for six RCTs and the "Risk of Bias in Non-randomized Studies - of Interventions" for one CCT revealed a moderate to high risk of bias. The meta-analysis of five studies showed that the overall risk of developing wound dehiscence was lower in the APC group (RR = 0.33; 95% CI: 0.16, 0.71; p = 0.005; χ2 = 0.82; I2 = 0%). Subgroup analyses based on study design further supported these findings. Although the adjuvant use of APC for alveolar cleft reconstruction reduces the risk of wound dehiscence, more studies with increased scientific rigour and fewer confounding variables are warranted.
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Affiliation(s)
| | - Karthik Sennimalai
- Department of Orthodontics, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu & Kashmir, India.
| | - Amanjot Kaur
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu & Kashmir, India.
| | - Madhanraj Selvaraj
- Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Nitika Monga
- Division of Non-Communicable Diseases, Indian Council of Medical Research Headquarters, New Delhi, India.
| | - Kaja Mohaideen
- Department of Dentistry, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
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Kobayashi S, Hirakawa T, Sugiyama M, Naruse M. Primary vomerine osteotomy with gingivoperiosteoplasty for bilateral cleft lip and palate patients with protrusion and/or torsion of the premaxilla. J Plast Reconstr Aesthet Surg 2024; 88:381-387. [PMID: 38064916 DOI: 10.1016/j.bjps.2023.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 01/02/2024]
Abstract
In patients with bilateral cleft lip and palate (BCLP) with protrusion and/or torsion of the premaxilla, achieving a favorable outcome with adequate facial and maxillary development remains challenging. In the present study, we report a retrospective cohort of patients with complete BCLP who were treated between 2017 and 2020 at a single center in Japan. We investigated the effects and complications of primary vomerine osteotomy (PVO) with gingivoperiosteoplasty (GPP) following pre-surgical orthodontics (PSO) for premaxillary protrusion and/or torsion. For patients with residual premaxillary protrusion and/or torsion after PSO, PVO, and GPP were performed. The distances and angles of the premaxilla were measured on dental casts before PSO, on the day of PVO, after PVO, and on the day of palatoplasty after cheiloplasty. We further assessed postoperative complications. From a total of 36 patients with complete BCLP after PSO, seven patients underwent PVO with GPP. Proper positioning of the premaxilla was achieved in all seven patients. The distance between the anterior edge of the premaxilla and the anterior edge of the lateral segment and the length of the premaxillary-lateral segment on both sides continued to decrease over time. Loosening of GPP sutures occurred in two cases, although no major complications such as necrosis of the premaxilla or fistula formation occurred. Vomerine osteotomy with GPP before primary cheiloplasty is a potential treatment option in BCLP when the premaxilla still protrudes despite PSO or because PSO cannot be applied.
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Affiliation(s)
- Shinji Kobayashi
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
| | | | - Madoka Sugiyama
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Masahiro Naruse
- Department of Dentistry, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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Normande Neto HDV, Oliveira-Neto OB, Ribeiro ILH, Andrade CSD, Sales PHDH, Lima FJCD. What is the Effectiveness of Premaxilla Surgical Repositioning and its Stabilization Methods in Mixed Dentition Patients With Bilateral Cleft Lip and Palate? Cleft Palate Craniofac J 2023; 60:1211-1219. [PMID: 35535395 DOI: 10.1177/10556656221096304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Verify the effectiveness of surgical repositioning of the premaxilla and its stabilization methods in patients with bilateral cleft lip and palate during mixed dentition. DESIGN Systematic review. MATERIAL AND METHODS The search was conducted in 7 databases (eg, Medline via PubMed; Scopus; Central Cochrane; LILACS; Embase, Web of Science; and Sigle via OpenGrey until August 2021), using the descriptors "premaxilla", "cleft Palate", and "bone transplantation". INCLUSION CRITERIA Clinical trials and observational studies that have patients with bilateral cleft who had a need for superior/posterior repositioning of the premaxilla on mixed dentition; Studies in any language was evaluted whitout time restriction of publication. RESULTS From 5572 records, 6 studies were included in the review with a total sample of 212 patients. Regarding the type of stabilization used in the premaxilla, the hybrid method (rigid and complementary semi-rigid stabilization) predominated, being observed in 184 patients (86.8%). A total of 17 failures were identified related to the surgical repositioning of the premaxilla, corresponding to 8% of the total number of surgeries. A meta-analysis of prevalence was performed, only with the retrospective studies. It was observed that the effectiveness rate of premaxilla repositioning was 92%, with a CI between 0.04 and 0.13, with all included studies showing a similar failure rate (0.08-0.09). The included studies also showed great homogeneity in this analysis (I2 = 0%; P = .75). CONCLUSION Although there are several alternatives and techniques for repositioning and stabilizing the premaxilla, the statistical result did not differ between the different techniques.
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Affiliation(s)
| | | | - Igor Lerner Hora Ribeiro
- Oral and Maxillofacial Surgeon at Santa Casa de Miséricrdia of São Miguel dos Campos, Alagoas, Brazil
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Singkhorn T, Pripatnanont P, Nuntanaranont T, Supakanjanakanti D, Ritthagol W. Influence of a resorbable collagen membrane for alveolar bone graft on clinical outcomes and ridge volume stability in cleft alveolus. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00465-9. [PMID: 36567198 DOI: 10.1016/j.ijom.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
This study compared the clinical outcomes, graft quality, and graft quantity after alveolar bone grafting with and without a resorbable collagen membrane. Twenty unilateral cleft patients undergoing defect repair with cancellous iliac bone were assigned to either the collagen membrane group (Mb group) or standard group without a membrane (St group). Postoperative pain and swelling, bone density, and bone volume and quality were assessed. The Mb group showed significantly lower postoperative pain than the St group (P < 0.001) and significantly less swelling (P < 0.01) on day 3 postoperative. The reduction in bone density was significantly greater in the St group than in the Mb group at 1 and 3 months postoperative (P ≤ 0.001), but not at 6 months. The reduction in bone volume in the St group was significantly greater than that in the Mb group at 3 months (29.11 ± 6.26% vs 17.67 ± 11.89%, P = 0.016) and 6 months postoperative (40.95 ± 6.81% vs 25.67 ± 11.51%, P = 0.002). Nine cases in the Mb group versus six in the St group showed good bone quality. In conclusion, the collagen membrane facilitated predictable clinical outcomes in bone maturation, bone volume preservation, and bone bridging in the alveolar bone graft.
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Affiliation(s)
- T Singkhorn
- Oral and Maxillofacial Surgery Section, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | - P Pripatnanont
- Oral and Maxillofacial Surgery Section, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | - T Nuntanaranont
- Oral and Maxillofacial Surgery Section, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - D Supakanjanakanti
- Oral and Maxillofacial Surgery Section, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - W Ritthagol
- Preventive Dentistry Section, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Chauhan JS, Sharma S. Lag screw fixation of the premaxilla during bilateral cleft lip repair. J Craniomaxillofac Surg 2019; 47:1881-1886. [PMID: 31812313 DOI: 10.1016/j.jcms.2019.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/19/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022] Open
Abstract
In synchronous primary premaxillary setback and cleft lip repair for bilateral cases with severely protruding premaxilla, stabilization of the premaxilla is mostly achieved by gingivoperiosteoplasty. This kind of repair carries risk of impairment of blood supply to the premaxilla and/or prolabium, and at the same time it cannot ensure adequate stabilization of the premaxilla postoperatively. To overcome these problems, we have developed a unique technique of fixation of the premaxilla. In this paper, we discussing this technique, its advantages, and potential complications associated with it. From 2016, 10 patients aged 4-10 months, with bilateral cleft lip and palate with premaxillary protrusion (≥10 mm) underwent premaxillary setback and cheilorhinoplasty in the same stage. Instead of gingivoperiosteoplasty, a 'lag screw' fixation technique was used to stabilize the premaxilla. The follow-up period ranged between 5 and 32 months. In all the cases, we achieved adequate stabilization of the premaxilla. None of the patients had any issue related to the vascularity of the premaxilla or prolabium. There was no impairment in the eruption process of deciduous teeth in the premaxillary segment. Overall aesthetic outcomes of the lip and nose were acceptable. This technique of premaxillary fixation with lag screw gives us the liberty to perform primary cheilorhinoplasty along with premaxillary setback in the same stage, without risking the vascularity of premaxilla and prolabium. It ensures adequate stabilization of the premaxilla, but evaluation of regular growth of the midface and, if needed, corrective orthodontic and surgical treatment in the follow-up periods are advisable.
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Affiliation(s)
- Jaideep Singh Chauhan
- Department of Maxillofacial Surgery & 'Smile Train' Cleft Centre, CHL Hospitals, AB Road, LIG Square, Indore, MP, India.
| | - Sarwpriya Sharma
- Department of Maxillofacial Surgery & 'Smile Train' Cleft Centre, CHL Hospitals, AB Road, LIG Square, Indore, MP, India.
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Kobayashi S, Yasumura K, Hirakawa T, Fukawa T, Maegawa J. Evaluation of Congenital Maxillary Growth Using Computed Tomography in Patients With Bilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:282-287. [PMID: 31522540 DOI: 10.1177/1055665619874979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze congenital lateral maxillary growth for patients with bilateral cleft lip and palate (BCLP). DESIGN A retrospective study. SETTING Kanagawa Children's Medical Center. MATERIALS Images from computed tomography (CT) of patients with BCLP and control patients that were previously used for treatment. MAIN OUTCOME MEASURES The following landmarks were used: A, the posterior most point of the piriform aperture; B, the superior most point of the acoustic meatus; C, the point at which line A-B intersects the line drawn perpendicular from line A-B to the maxillary tuberosity; and D, the apical most point of the nasal bone. The following distances were then measured using these landmarks: (1) A-B distance; (2) A-C distance; (3) A-C/A-B; (4) the angle between lines A-B and A-D (∠BAD); and (5) B-D distance. RESULT Mean A-B and A-C distances and A-C/A-B were significantly smaller in the BCLP group than in the control group (P < .01 each). Mean ∠BAD was significantly larger in the BCLP group than in the control group (P < .01). Mean B-D distance did not differ significantly between groups. CONCLUSIONS Our results indicated that the lateral maxillary segments of patients with BCLP were more posterior than those of the control group, and segment length was shorter compared to the control group on 3D-CT analysis. The lateral maxillary segments of patients with BCLP were basically suggested to originally be underdeveloped.
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Affiliation(s)
- Shinji Kobayashi
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Kazunori Yasumura
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | | | | | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan
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Orthodontic premaxillary setback versus premaxillary osteotomy with gingivoperiosteoplasty for Bilateral cleft lip and palate patients: 4-year observation outcomes. J Plast Reconstr Aesthet Surg 2019; 72:1813-1818. [PMID: 31272878 DOI: 10.1016/j.bjps.2019.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022]
Abstract
Patients with bilateral cleft lip and palate (BCLP) generally require several stages of treatment, and adequate maxillary development without orthognathic surgery is not easy to achieve. The purpose of this study was to determine short-term outcomes of orthodontic premaxillary setback (OPS) and premaxillary osteotomy (PO) for complete BCLP treatment. PATIENTS AND METHODS Twenty-six patients with BCLP were consecutively treated for 4 years by a single surgeon. All patients were categorized by three indications for the first operation: OPS1, cheiloplasty + gingivoperiosteoplasty (GPP) + palatoplasty; OPS2, cheiloplasty + GPP; and PO, cheiloplasty + GPP + PO. Cephalograms for maxillary growth and velopharyngeal function (VPF) were judged at 4 years old, before orthodontic treatment. RESULTS OPS1 was performed in 14 cases, OPS2 in 8 cases, and PO in 4 cases. As for cephalometric analysis at 4 years old, no significant differences between groups were seen in any cephalometric measurements. As for speech outcomes, assessment of VPF at 80.8±14.8 months was good in 17 cases, slightly impaired in 8 cases, and marginally impaired in 1 case, with no severely impaired cases. DISCUSSION No significant differences in maxillary growth or speech outcomes were seen between OPS1, OPS2, and PO groups at 4 years old, possibly because all groups showed the same position of the premaxilla after the first operation. CONCLUSIONS No significant differences in maxillary growth or speech outcomes were seen for 26 patients with BCLP between OPS1, OPS2, and PO groups at 4 years old. However, the long-term growth characteristics remain unclear.
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Bittermann GKP, van Es RJJ, de Ruiter AP, Frank MH, Bittermann AJN, van der Molen ABM, Koole R, Rosenberg AJWP. Incidence of complications in secondary alveolar bone grafting of bilateral clefts with premaxillary osteotomy: a retrospective cohort study. Clin Oral Investig 2019; 24:915-925. [PMID: 31250194 DOI: 10.1007/s00784-019-02977-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate factors affecting incidence of complications after secondary alveolar bone grafting with premaxillary osteotomy (SABG + PO) in children with complete bilateral cleft of lip and palate (BCLP). MATERIALS AND METHODS Data were collected from children with BCLP treated with SABG + PO from 2004 to 2014 at our institute. Preoperative parameters included age, donor site, race, gingival health, bone quality around cleft-related teeth, premaxilla position, graft timing, presence of canines in the cleft, and presence of deciduous teeth around the cleft area. Logistic regression and the chi-squared test were used to assess correlations and the incidence of complications. RESULTS In the 64 patients, a significant correlation was found between complication rate and timing of bone grafting with respect to early versus late SABG + PO (p = 0.041), age > 12 years (p = 0.011; odds ratio (OR) 5.9; 95% confidence interval (CI) 1.49-23.93), malposition of the premaxilla (p = 0.042; OR 3.3; 95% CI 1.04-10.13), and preoperative bone quality around cleft-related teeth (p = 0.005; OR 5.3; 95% CI 1.6-17.2). CONCLUSIONS The timing of SABG + PO is essential, as early SABG + PO is associated with fewer complications. A malpositioned premaxilla and poor bone quality around cleft-related teeth are associated with more complications. Therefore, preoperative orthodontic repositioning of the malpositioned premaxilla before SABG + PO should be considered. CLINICAL RELEVANCE Analysis of treatment protocols and complications for BCLP patients underscores that proper timing of SABG + PO and correct premaxilla repositioning help reduce complications.
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Affiliation(s)
- Gerhard K P Bittermann
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands.
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| | - Adrianus P de Ruiter
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| | - Michael H Frank
- Department of Oral and Maxillofacial Surgery, Haaglanden Medical Centre, PO Box 432, 2501 CK, The Hague, The Netherlands
| | - Arnold J N Bittermann
- Department of Pediatric Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB, Utrecht, The Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Ron Koole
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
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Sierra NE, Ferrer-Fuertes A, Salazar-Perez B, Cho-Lee GY, Martí-Pages C, Rivera-Baró A, Rubio-Palau J, García-Diez EM. Surgical Repositioning of the Premaxilla Using a Minimally Invasive Endonasal Approach. Cleft Palate Craniofac J 2018; 55:830-836. [DOI: 10.1597/16-057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to evaluate a technique for the surgical repositioning of the premaxilla using a minimally invasive endonasal approach. Design: Retrospective review of clinical records. Setting: Tertiary care, University Hospital, pediatric maxillofacial surgery unit. Patients: Twenty-one patients (12 boys and 9 girls), ages ranging from 6 to 21 years, with BCLP+A and premaxillary malposition (PM). Interventions: Surgical repositioning of the premaxilla (SRP) using a minimally invasive endonasal approach, from November 2007 to November 2015. Main outcome measures: Achieving maxillary arch alignment and premaxillary stability was defined as treatment success. Intraoperative and postoperative complications were also recorded. Results: In all cases (100%), the treatment was successful either at first surgery or after reoperation. Two patients (9.5%) were reoperated-one due to premaxillary instability and one due to PM relapse. There were no perioperative complications. Conclusions: SRP using a minimally invasive endonasal approach is a safe and effective technique that levels and aligns the maxillary arch in preparation for SABG, which minimizes the risk of wound infection and premaxillary vascular compromise. The endonasal approach improves tissue quality of the mucoperiosteal flaps when performing the SABG procedure. Further prospective studies are needed to elucidate the best protocols and techniques for the management of PM in patients with BCLP+ A.
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Synchronous Premaxillary Osteotomy with Primary Cheiloplasty for BCLP Patients with Protrusion of the Premaxillae. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1402. [PMID: 29263944 PMCID: PMC5732650 DOI: 10.1097/gox.0000000000001402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/16/2017] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: In bilateral cleft lip and palate (BCLP) patients with protrusion and/or torsion of the premaxillae, it is difficult to achieve a good outcome. We have developed a series of procedures of premaxillary osteotomy with primary cheiloplasty for BCLP patients who did not respond well to presurgical orthodontics (PSO). Methods: A total of 27 BCLP patients with protrusion and/or torsion of the premaxillae underwent PSO. For 3 BCLP patients in whom the protruded premaxillae could not be returned to a good position, a primary premaxillary osteotomy and gingivoperiosteoplasty (GPP) with cheiloplasty were performed simultaneously. Subsequently, Furlow palatoplasty was performed by one and a half years of age. Maxillary growth was evaluated by dental occlusion at 4 years of age. Results: A premaxillary osteotomy and GPP with cheiloplasty were performed at 6 months. The patients’ facial structures improved, their premaxillae were positioned more superiorly, and normal inclination of the incisors was achieved. They had edge-to-edge occlusions or cross bites at 4 years of age. Conclusions: As advantages, the patients’ facial structures improved, and the alveolar bones were formed by GPP. As a disadvantage, premaxillary necrosis might occur because of poor blood circulation. It is important to secure the following 2 blood supplies: from the periosteum and soft-tissue of the anterior premaxillae and from the periosteum and mucosa of the nasal septum. Synchronous premaxillary osteotomy and GPP with primary cheiloplasty are appropriate when the premaxillae cannot be properly repositioned by PSO or PSO cannot be done.
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Elhaddaoui R, Bahije L, Zaoui F, Rerhrhaye W. [Timing of alveolar bone graft and sequences of canine eruption in cases of cleft lip and palate: a systematic review]. Orthod Fr 2017; 88:193-198. [PMID: 28597839 DOI: 10.1051/orthodfr/2017011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The alveolar bone graft (ABG) is an important phase in the surgical treatment of cleft lip and palate (CLP). The purpose of alveolar bone grafting is to eliminate oronasal fistulas, restore the continuity of the maxilla and provide optimal periodontal support for spontaneous eruption of permanent canines adjacent to the cleft. The purpose of this systematic review was to determine the ideal timing of the ABG that would achieve these goals. MATERIAL AND METHODS Databases consulted were MEDLINE, Embase et EBSCOhost, using keywords present in the MeSH: [cleft lip and palate] and [alveolar bone graft] and [tooth eruption]. Selection criteria included retrospective studies, prospective studies and meta-analyzes dating from January 2005, with available full text. RESULTS Among 105 references, 9 articles met our selection criteria. ABG carried out before or just after the eruption of permanent canines adjacent to the cleft, between 8 and 12 years old, has the best success rate of the transplant (71% to 89%) and the lowest risk of canine inclusion (5% to 19%). CONCLUSION According to literature data, the optimal timing of ABG that provide best results is located between 8 and 12 years, before or just after the eruption of permanent canines adjacent to the cleft. However, this timing could be modified by the multidisciplinary team according priorities, particularly aesthetic, defined for each child.
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Scott R, Scott J, Stagnell S, Robinson S, Flood T. Outcomes of 44 Consecutive Complete Bilateral Cleft Lip and Palate Patients Treated with Secondary Alveolar Bone Grafting and Premaxillary Osteotomy. Cleft Palate Craniofac J 2017; 54:249-255. [DOI: 10.1597/15-162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To report the surgical outcomes of secondary alveolar bone grafting with premaxillary osteotomy in a single surgeon cohort of complete bilateral cleft lip and palate patients. Design Retrospective review of 44 consecutive patients using hospital notes and radiographs. Setting Single specialist cleft lip and palate center, UK. Patients Consecutive patients with complete bilateral cleft lip and palate who were being treated with secondary alveolar bone grafting incorporating premaxillary osteotomy. Outcome Measures Assessment of success of bone graft by Kindelan score; canine eruption; closure of fistulae and assessment of morbidity. Results Between January 6, 2000, and August 8, 2013, 44 patients with complete BCLP underwent secondary ABG with a premaxillary osteotomy as a one-stage procedure. The mean follow-up was 7.3 years (range 1.4 to 14.6). Eighty-five percent of ABGs were successful (a Kindelan score of 1 or 2), and canine eruption was 89%. Failure of the ABG occurred in 7%. Fistulae recurrence rate was 11%, all of which were asymptomatic. No premaxillae were devitalized. Conclusion Incorporating a premaxillary osteotomy into the secondary ABG surgical protocol can be a safe technique that gives excellent surgical exposure for fistula repair.
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Affiliation(s)
- Rupert Scott
- Oral & Maxillofacial Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, Devon, United Kingdom
| | - Julia Scott
- Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Sami Stagnell
- Salisbury District Hospital, Salisbury, United Kingdom
| | - Steve Robinson
- Spires Cleft Centre, Salisbury District Hospital, Salisbury, United Kingdom
| | - Tim Flood
- Oral & Maxillofacial Surgeon, Spires Cleft Centre, Salisbury District Hospital, Salisbury, United Kingdom
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Atherton DD, Boorman JG. Use of a purified collagen membrane to aid closure of palatal fistulae. J Plast Reconstr Aesthet Surg 2016; 69:1003-7. [DOI: 10.1016/j.bjps.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 01/01/2016] [Accepted: 02/18/2016] [Indexed: 11/25/2022]
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Stabilization of premaxilla repositioned during secondary bone grafting in complete bilateral cleft lip and palate patients. J Craniofac Surg 2015; 25:1554-7. [PMID: 24926720 DOI: 10.1097/scs.0000000000000865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Secondary bone grafting simultaneous to premaxillary repositioning is a well-recognized surgical procedure for the management of bilateral cleft lip and palate patients. Proper stabilization of the repositioned premaxilla is considered as a key factor for the success of secondary bone grafting because the mobility of the premaxillary segment jeopardizes graft integration. This case series reports a reliable method of premaxillary stabilization that incorporated the intrasurgical application of resin bone cement to cover and reinforce the arch bars or orthodontic brackets applied on the maxillary teeth. Occlusal loads were reduced by application of posterior bite blocks on the mandibular teeth. The stabilization method was performed on 7 patients (5 women and 2 men) with a mean age of 12.4 years. During postsurgery follow-ups, the repositioned premaxillary segments did not show mobility in any of the patients. The palatal fistulae were completely closed. Panoramic radiographies taken 2 months after surgery demonstrated acceptable graft integration. The patients have now been followed up to 5 years. No evidence of relapse has been observed. This technique seemed to be undemanding, included minimal laboratory procedure, and maintained the labial mucosa overlying the repositioned segment intact.
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Bittermann GKP, de Ruiter AP, Janssen NG, Bittermann AJN, van der Molen AM, van Es RJJ, Rosenberg AJWP, Koole R. Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us? Clin Oral Investig 2015; 20:207-17. [PMID: 26374747 PMCID: PMC4762918 DOI: 10.1007/s00784-015-1589-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/01/2015] [Indexed: 11/26/2022]
Abstract
Objective In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition. Materials and methods A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract. Results Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting. Conclusions An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting. Clinical relevance The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.
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Affiliation(s)
- Gerhard K P Bittermann
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
| | - Ad P de Ruiter
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Nard G Janssen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Arnold J N Bittermann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aebele M van der Molen
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - R Koole
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
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Premaxillary osteotomy fixation in bilateral cleft lip/palate: Introducing a new technique. Asian J Surg 2015; 39:90-5. [PMID: 26138519 DOI: 10.1016/j.asjsur.2015.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 03/09/2015] [Accepted: 03/23/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In bilateral cleft lip/palate patients, sometimes the premaxilla is severely protruded and twisted. In such situations premaxillary osteotomy is beneficial. In this article a new technique for fixation of premaxilla after osteotomy is presented. METHODS The lip-split approach and premaxillary osteotomy and ostectomy from bony nasal septum were carried out. Fixation of osteotomized premaxilla was achieved with low profile miniplate or microplate. Bone grafting of that side was performed during the same session. RESULTS This procedure was performed in three patients, with good labial repair after the lip split. The bone graft was successful in all the three cases and there were no complication for premaxillary osteotomy in this series. CONCLUSION In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty.
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Mahmood R, Flood T, Robinson S, Al-Gholmy M. Early Orthopedic Retraction of the Premaxilla in Bilateral Complete Cleft Lip and Palate: An Innovative Approach to a Difficult Problem. Cleft Palate Craniofac J 2015; 53:363-7. [PMID: 25647517 DOI: 10.1597/14-045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bilateral cleft lip and palate occurs in 9.2% of cleft patients. Many approaches have been adopted to manage the protrusive premaxillary segment in patients with bilateral cleft lip and palate. Some advocate the use of intraoral appliances, occasionally combined with invasive surgery, which often requires revision at a later date. The authors describe the case of a 3-year-old child born with bilateral cleft lip and palate presenting with a protuberant premaxilla and an overjet greater than 25 mm. Prompt intervention was warranted in this case due to the potential for traumatic compromise to the dentition of the premaxillary segment and a distinct lack of social integration reported by the parents. The patient was managed with a novel, innovative approach using orthodontic traction and minimally invasive surgery. The literature has been reviewed and the patient's subsequent physiological and psychosocial development has been monitored. He has since undergone successful alveolar bone grafting.
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18
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Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap. J Plast Reconstr Aesthet Surg 2013; 66:1212-8. [DOI: 10.1016/j.bjps.2013.04.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
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19
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Lee UL, Cho JB, Choung PH. Simultaneous Premaxillary Repositioning and Cheiloplasty in Adult Patients with Unrepaired Bilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2013; 50:231-6. [DOI: 10.1597/09-225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary cheiloplasty in adult patients with unrepaired complete bilateral cleft lip and palate is quite challenging due to severe premaxillary anterior projection. To get the best repair results, the author carried out repositioning of the premaxilla and repair of the lip deformity in a single stage. Positive results for the primary lip repair and appropriate repositioning of the premaxilla were achieved. No avascular necrosis of the premaxilla was observed. Repositioning of the premaxilla and repair of the lip deformity in a single operation appears to be a reliable method for treating adult patients with previously unrepaired or poorly repaired bilateral cleft lip and palate.
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Affiliation(s)
- Ui-Lyong Lee
- Tooth Bioengineering National Research Lab, BK21, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jun-Bum Cho
- Department of Oral & Maxillofacial Surgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Pill-Hoon Choung
- Department of Oral and Maxillofacial Surgery, Chungang University Hospital, Seoul, Korea who was dispatched to Ethiopia to perform the surgeries
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Okada W, Fukui T, Saito T, Ohkubo C, Hamada Y, Nakamura Y. Interdisciplinary treatment of an adult with complete bilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2012; 141:S149-58. [DOI: 10.1016/j.ajodo.2011.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 11/15/2022]
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Singh M, Flood T, Mahmood R, Sanghrajka N. Stabilisation of premaxillary segment in bilateral cleft palate during alveolar bone graft. Br J Oral Maxillofac Surg 2012; 50:678-9. [PMID: 22277699 DOI: 10.1016/j.bjoms.2011.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/31/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Mark Singh
- Oral & Maxillofacial Surgery Department, Salisbury District Hospital, Odstock Rd, Salisbury SP2 8BJ, United Kingdom.
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Jensen J, Küseler A, Klit Pedersen T, Norholt S. Premaxillary Osteotomy and Bone Grafting for Secondary BCLP Repair - Long-Term Evaluation of Growth. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gomes KU, Rapoport A, Carlini JL, Lehn CN, Denardin OVP. Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip. Braz J Otorhinolaryngol 2009; 75:537-43. [PMID: 19784423 PMCID: PMC9446007 DOI: 10.1016/s1808-8694(15)30493-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 10/29/2008] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS as far as the care protocol is concerned, results show a 90% success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76% sought treatment for personal satisfaction reasons and 86% reported having had more self-confidence after the surgery. CONCLUSIONS Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96% of them were pleased with the results attained, which facilitated their social inclusion and re-integration.
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Gomes KU, Rapoport A, Lehn CN, Denardin OVP, Carlini JL. O impacto na qualidade de vida após o reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral - estudo de 50 casos. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000600004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever o protocolo de tratamento no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF); (b) avaliar as motivações e expectativas em relação ao tratamento e (c) avaliar a percepção de inclusão e integração social obtida pelo procedimento. MÉTODO: Estudo observacional, retrospectivo com todos os 50 participantes recrutados entre os pacientes submetidos ao procedimento de reposicionamento de pré-maxila, no período de janeiro de 2003 a julho de 2005, no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF), Paraná. Foi aplicado questionário de avaliação RESULTADOS: Com relação ao protocolo de atendimento, os resultados evidenciaram sucesso em 90% das cirurgias. Quanto às expectativas cirúrgicas e de integração social, estas mostraram que 76% procuraram a cirurgia por motivos de insatisfação pessoal e, 86% relataram maior confiança em si mesmo, após a cirurgia. CONCLUSÃO: O protocolo de reposicionamento cirúrgico da pré-maxila é uma técnica viável para o tratamento dos pacientes portadores de fissura bilateral do processo alveolar; a maioria dos pacientes submetidos ao tratamento de reposicionamento de pré-maxila percebeu o tratamento como continuidade dos cuidados dispensados, participou por indicação médica, com expectativa de melhora no aspecto pessoal e melhora da autoconfiança e, 96% deles, manifestaram satisfação com os resultados obtidos, o que facilita a inclusão e integração social dos mesmos.
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16:394-7. [PMID: 18626261 DOI: 10.1097/moo.0b013e32830c1edc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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